Antoine Abu-Musa, MD, PhD
Department of Obstetrics and Gynecology, AUBMC
Gestational diabetes mellitus (GDM) complicates 1%–16% of pregnancies. GDM is associated with several poor short-term maternal and fetal outcomes, and treatment of GDM improves pregnancy outcome. GDM is confined to the pregnancy state and in most cases resolves itself spontaneously in the postpartum period. Nevertheless, women with GDM during pregnancy were found to be at an increased risk for future adverse outcome. GDM is increasing in prevalence, driven by greater maternal obesity and weight gain during pregnancy.
RISK FOR THE MOTHER
One of the most common long-term complications of GDM is the development of subsequent type 2 diabetes mellitus. At least half of the women with GDM will develop type 2 diabetes mellitus later in life. In addition, GDM is associated with future cardiovascular disease (CVD). Studies have reported a 66% to 85% higher risk of CVD, including coronary artery disease, myocardial infarction, and/or stroke. Another important recent finding is the association between GDM and adverse urinary system-related long-term outcomes.
GDM was associated with both stress urinary incontinence and mixed urinary incontinence up to 2 years following delivery with more profound symptoms in those who required insulin during pregnancy. Moreover, in pre-menopausal women, a history of GDM was found to be associated with almost doubled risk for overactive bladder.
RISK FOR THE OFFSPRING
The intrauterine environmental or nutritional status seems to be involved in the fetal programming and offspring exposed to maternal hyperglycemia are prone to develop mainly metabolic-related diseases later in life. The offspring are at increased risk of developing impaired glucose tolerance, hypertension, overweight and obesity, and dyslipidemia. It is well documented that the offspring of women with GDM are at considerable risk for diabetes at a young age, with an almost 8-fold increased risk of diabetes. Also GDM is associated with increased future risk of obesity, adiposity and increased abdominal circumference in children ages 5-7 years. Moreover, offspring of women with GDM have higher systolic blood pressure compared with controls. This could lead to future hypertension.
PREVENTION AND RISK REDUCTION
GDM has significant implications not only for the outcome of pregnancy, but certainly also for the future of both mother and child. Lifestyle intervention has been documented to prevent or limit the development of these severe conditions. It is therefore mandatory to diagnose and treat GDM and, furthermore, to follow mothers and their offspring after pregnancy, given their increased risk of diabetes. Maternal glycemic control may help to prevent adverse long-term outcome of the offspring, lowering the risk of being overweight. Other factors of prevention, for example weight control, special diet, and regular exercise are recommended to both the mother and her child as part of a comprehensive management plan. Finally, breastfeeding (for at least 6 months) compared with formula feeding has shown to have beneficial effects on glucose tolerance, hypertension, dyslipidemia, and obesity for both mother and offspring.